Why unions are turning on Obamacare

The Affordable Care Act continues to generate controversy. There are obviously many paths to the same destination. Today's post was shared by Steven Greenhouse and comes from tv.msnbc.com

 (Photo by David Kohl/AP)

President Barack Obama speaks at the AFL-CIO Labor Day picnic at Coney Island in Cincinnati Sept. 7, 2009. Some labor unions that initially backed Obama’s health care overhaul are now frustrated and angry about what they say are unexpected consequences of the plan that could hurt their members.

“Repeal and replace” is the Grand Old Party’s oft-repeated mantra regarding Obamacare, which House Republicans voted to repeal for the 40th time on Friday. But in April, an organization in the president’s base echoed the refrain.

On April 24, the United Union of Roofers, Waterproofers, and Allied Workers released a statement demanding “repeal or complete reform of the Affordable Care Act.” While no other union has yet called for an outright repeal of the health care law, a growing number of them argue that serious reform is needed.

“We continue to stand behind real health care reform, but the law as it stands will hurt millions of Americans including the members of our respective unions,” wrote the presidents of three major labor unions in a July letter to Congressional Democratic leadership. The subsequent three and a half weeks have not assuaged their fears.

“There are members of Congress who have met with us who have been somewhat responsive and concerned about the situation,” said a spokesperson for the hospitality union UNITE HERE, whose president signed the letter. “But...

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Physician Payments Sunshine Act Goes Into Effect Without Initial Concerns

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

The Physician Payments Sunshine Act, an Affordable Care Act provision requiring doctors and medical companies to disclose their financial relationships, went into effect Aug. 1. Physicians say they are now working to find a balance between necessary transparency and what some perceive to be burdensome filing.

“We want to spend our time seeing patients, not doing paperwork,” said Dr. Jason Mitchell the director of the Center for Health IT at the American Academy for Family Physicians.

The Sunshine Act requires drug companies and medical device makers to report payments, gifts and investments to Centers for Medicare and Medicaid Services. Though the act is now in effect, a complete set of records are not due until March 2014 and will not be made public until September 2014.

Consumer advocates and other stakeholders favor openness when it comes to the large amounts of money medical and pharmaceutical companies spend to influence a doctor’s choices, according to a Pew Health Center statement from 2012. Holding both parties accountable with a clear reporting system would allow consumers to spot potential bias.

Mitchell, who is also a practicing family medical physician in Missouri, does not anticipate many immediate changes for doctors – aside from fewer lunches with pharmaceutical representatives.

He predicts that because of the increased attention placed on these small meetings that make up a majority of the reportable interactions,...

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A Conservative Re-Envisioning Of The Health Care Overhaul

Today's post was shared by Kaiser Health News and comes from capsules.kaiserhealthnews.org

Tired of hearing policy experts and politicians debate the 2010 health care law?  What if you took the Affordable Care Act out of the conversation?  If you could scrap the nation’s current health care system and build a new one, what would it look like?

A group of health care experts from Stanford University, the Harvard Kennedy School of Government and the University of Southern California, among other institutions, has compiled a report with their answer to that question.  Funded by the conservative-leaning American Enterprise Institute’s National Research Initiative, the document offers a variety of ideas that its authors say would achieve universal coverage, protect the poor and the sick and restrain health care cost growth, among other priorities.

“In many ways, the ACA has been a distraction, because people think that all of the health care debate boils down to ‘do you support the ACA or do you oppose it?’ ” said Darius Lakdawalla, one of the authors and a visiting scholar at the American Enterprise Institute, as well as a  professor of pharmaceutical economics in the University of Southern California School of Pharmacy. “To us, that is really a very narrow and misleading question.”

The report’s proposals include allowing health insurers to charge premiums that reflect consumers’ health care costs and providing generous subsidies to help the poor obtain...

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Texas Pointing Way to Healthy Market

Today's post was shared by WorkCompCentral and comes from daviddepaolo.blogspot.com

The health of the workers' compensation industry has direct ties to the health of the economy.

This makes absolute sense - an employer's premium is calculated in large part by the size of an employer's payroll, modified by the type of jobs that are being performed by the employees represented by that payroll.

Texas' had not been as hard hit by the recession as the other large states, and now it appears that the state is really taking off, economically, if the adage that workers' compensation reflects the economy is to be believed.

Here's the good stats:

Written premiums increased 13.1% from 2011 to 2012 according to the Independent Insurance Agents of Texas.

The state's dominant carrier, Texas Mutual, saw its share of the market increase by 3.3% over the same period, from 33.8% in 2011 to 37.1% in 2012.

The even better news for Texas is that, based on Texas Department of Insurance statistics, Texas Mutual wrote $244 million in premium during the fourth quarter of 2012, with the residual market accounting for only $1.4 million in premium. According to the same report, Texas Mutual's residual market premiums have stayed relatively stable since 2007, the first year in the report.

Texas is an optional state. I take this information two ways: either more employers are opting in and qualifying outside of the risky, residual market underwriting standards, or those with high risk and, ergo, high potential premium, are going bare and never entering the work comp market.

But the kicker is...

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Chevron pleads no contest to criminal charges stemming from Richmond refinery fire

Today's post was shared by FairWarning and comes from www.contracostatimes.com

Click photo to enlarge

MARTINEZ -- Chevron will pay $2 million in fines and restitution after pleading no contest Monday to six misdemeanor criminal charges stemming from a fire at its Richmond refinery last year.

Chevron attorneys accepted the terms, including 3 1/2 years of probation, $1.28 million in fines, and more than $720,000 in restitution payments to three different agencies.

The penalties resulted from joint charges filed Monday in Contra Costa Superior Court by state Attorney General Kamala Harris and Contra Costa County District Attorney Mark Peterson. The terms of the plea had been agreed to by both sides before Monday's hearing.

"This criminal case achieves our goals of holding Chevron accountable for their

conduct, protecting the public, and ensuring a safer work environment at the refinery," Peterson said in a news release. Peterson also praised Chevron for its "commitment to do more than what is required by law" to prevent future accidents.

Chevron committed six violations of labor, health and safety standards, according to the complaint. The violations included failure to "correct deficiencies" in equipment, negligent emissions and failure to prevent employees' exposure to hazardous conditions.

The Aug. 6 fire knocked out the refinery's No. 4 crude unit and sent more than 15,000 people to area hospitals complaining of respiratory discomfort and other symptoms. Subsequent investigations have revealed that the fire was caused by a corroded pipe that failed,...

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Claimants’ expert in Garlock trial suggests $1.3 billion settlement figure

Today's post was shared by Legal Newsline and comes from legalnewsline.com

Bates

CHARLOTTE, N.C. (Legal Newsline) – A consultant tapped by attorneys representing claimants suing Garlock Sealing Technologies for asbestos exposure estimated the gasket manufacturer would need to devote more than $1.365 billion to a trust to settle pending and future claims against the company during testimony given Thursday.

Mark Peterson, a lawyer with a Ph.D. in social psychology who does estimations for trusts, said based on litigation trends from the past five years, the company would need to devote at least that much money to cover liability Garlock would likely face from people who will develop cases of mesothelioma in the coming years.

Judge George Hodges will ultimately decide how much money the company will need to devote to escape bankruptcy. The bankruptcy trial, which began two weeks ago at the U.S. Bankruptcy Court for the Western District of North Carolina and is expected to end on Tuesday, will determine the estimated liability of the company for current and future asbestos claims.

Peterson’s estimation is in stark contrast with that of a Garlock consultant who came up with a figure of about $270 million in his own estimation. Charles Bates, chairman of the economic consulting firm Bates White LLC and former assistant professor in the economics department at Johns Hopkins University testified about an estimation report his firm created to assess how much Garlock should put in the trust to compensate valid claimants.

Bates estimated $25 million...

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Fitch report: Workers comp will be hit hard if TRIA not extended

Today's post was shared by WCBlog and comes from ifawebnews.com

Fitch Ratings has issued a report on what it believes will be the impact on different aspects of business should the Terrorism Risk Insurance Act not be renewed. Present legislation, the Terrorist Risk Insurance Program Reauthorization Act, doesn’t expire until Dec. 31, 2014, but renewals of current policies will begin in January.

TRIA was passed after the 9/11 terrorism attacks to act as a backstop of sorts in the event a future event yielded similar financial losses.

The report finds that the most critical impact will be on workers compensation. Reduced workers’ compensation coverage availability would have broad economic consequences for employers, according to the report. Workers’ compensation insurers could be especially susceptible to large losses if a major terrorist event takes place without TRIPRA coverage. “Recognition of this vulnerability may lead to a withdrawal of insurer’s underwriting capacity from the workers’ compensation market, particularly in industries and geographic areas with greater perceived risk of terrorism-related losses,” Fitch said in its report.

Impact will also be felt in commercial property and business interruption lines of insurance, in addition to insurer credit ratings and the commercial mortgage-backed securities market.

The report cautions that if TRIA is not renewed, “demand for private market terrorism insurance protection will inevitably increase and premium rates will significantly...

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BP ordered to pay $130 million to oil spill claims administrator

Today's post was shared by JURIST and comes from jurist.org

[JURIST] Judge Sally Shushan of the US District Court for the Eastern District of Louisiana [official website] on Wednesday ordered British Petroleum (BP) [corporate website] to pay the third quarter and some fourth quarter expenses for the gulf oil spill claim administration program [official website website]. The budget and fees for the program totaled over $130 million. This order comes as the FBI esearches allegations by BP that the disbursement process has been corrupted. Although Shushan acknowledged that BP raised legitimate concerns about claims administrators approving false filings for a percentage of the payouts, she concluded that the program could not be halted on short notice based on the allegations alone. Although BP appealed immediately, US District Judge Carl Barbier, who is overseeing the spill litigation, upheld the decision within hours. The claim administration program is expected to continue operations while the court-appointed administrator and several former employees are investigated for fraud [FBI summary].

The 2010 Deepwater Horizon oil spill [JURIST news archive] in the Gulf of Mexico is one of the largest commercial disasters in modern history, and was responsible for the destruction of protected wildlife habitats that are still under reconstruction to this day. Two weeks ago, the US Department of Justice (DOJ) [official website] announced that Halliburton Energy Services [corporate website; JURIST news archive] agreed to plead guilty to...

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Debtors’ in asbestos bankruptcy case appeal estimation decision to Third Circuit

Today's post was shared by Legal Newsline and comes from legalnewsline.com

Fitzgerald

But then came Fitzgerald’s 50-page May 20 memorandum opinion in which the Delaware-based jurist estimated the liabilities of Specialty Products Holding Corp. and Bondex International to be in the neighborhood of $1.1 billion, many millions of dollars higher than what the debtors contended the true figure to be.

An expert working for the bankrupt companies – they are referred to as ‘debtors’ in bankruptcy proceedings as opposed to ‘defendants’ in the tort system – had estimated total future liabilities at between $465 million to $700 million nominal or $300 million to $575 million net present value.

In the end, Fitzgerald, who retired from the bench shortly after rendering her decision in the case, estimated the liabilities to be closer to the figures thrown out by attorneys representing the Official Committee of Asbestos Personal Injury Claimants and the Future Claimants’ Representative, numbers that were in the billion-dollar range.

Appropriate estimate

In her May decision, Fitzgerald wrote that after considering all of the evidence in the case, exhibits and arguments presented to the court during a weeklong estimation hearing in Pittsburgh earlier this year and during subsequent briefs and other legal filings, she considered an appropriate estimate for mesothelioma claims, pending and future, to be $1.1 billion net present value.

The judge also determined that an additional six percent, or $66 million, would have to be...

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Plaintiffs’ expert in lead paint trial says industry took responsibility for public health

Today's post was shared by Legal Newsline and comes from legalnewsline.com

Markowitz

SAN JOSE, Calif. (Legal Newsline) – Manufacturers of lead based pigments and paints were aware of the dangers lead exposure posed nearly 100 years ago, but promoted them anyway, according to testimony from the latest expert witness in a public lawsuit against current owners of former lead paint and pigment manufacturing companies.

Dr. Gerald Markowitz, a historian and professor at City University of New York, blamed a deregulation principle that allowed paint companies to continue mixing lead in paint for generations, despite known and documented health hazards within the paint industry.

“There was a firm belief in the U.S. up until very recently that regulation of toxic substances, except in food, should not be regulated,” Markowitz said. “It was a firm belief within (the) industry that they had responsibility rather than government to protect the workforce and protect the public.”

Markowitz testified at trial Wednesday in a case brought by 10 cities and counties in California, including Los Angeles County and the cities of San Diego and San Francisco, against companies and parent companies of one-time lead-based paint makers. The plaintiffs want the companies to pay for the cost of eliminating lead paint from homes in their jurisdictions. Defendants include The Sherwin-Williams Company, ConAgra Grocery Products, DuPont and Atlantic Richfield Company.

The People of California v. Atlantic Richfield Company et al is being heard...

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Move Over: Obesity as a medical condition is coming to workers' compensation

The recent action by the American Medical Association to recognize obesity as a medical condition is going to have a super-sized impact on workers' compensation systems throughout the nation. Today's post is shared from insurancejournal.com

Report: Obesity Monkier to Impact California Workers’ Comp

"The recognition of obesity as a disease may have a significant impact on workers’ compensation claims in California, a group said in a report on Thursday.

The group issued the report following a decision in June by the American Medical Association House of Delegates to reclassifying obesity as “a disease state.”

In the past obesity in workers’ comp went largely unreported because it was not considered a condition that needed to be addressed to treat most work related injuries or illnesses, according to the report from the California Workers’ Compensation Institute.

But with obesity reclassified as a disease medical providers may feel a greater responsibility to counsel obese patients about their weight, or if treatment for a compensable injury causes significant weight gain, CWCI stated in its report........


Read the entire article

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The Importance of Occupational Safety and Health: Making for a “Super” Workplace

Today's post was shared by Safe Healthy Workers and comes from blogs.cdc.gov

August 7th, 2013 9:39 am ET  -  Jaclyn Krah, MA; Richard L. Unger

Graphic by Stephen R. Leonard

There’s just something about superhero movie summer releases that gets us here at NIOSH excited about safety. This summer the source of our inspiration came from theMan of Steel© movie. In the film, pre-Superman Clark Kent is working as a commercial fisherman (a hazardous job if you’re not a man of steel). He risks exposing his amazing abilities when he swoops in to save the workers on a nearby oil rig who are in great danger as the rig implodes around them.

The scene is reminiscent of Action Comics© issue #3, the original Superman comic book series dating all the way back to 1938. In Action Comics #3, “Superman Battles Death Underground“, (issued 75 years ago this month) Superman is in the right place at the right time to save a coal miner, as well as his rescue crew, from an unsafe mine filled with toxic gas. We see instances such as these riddled throughout comic books and superhero movies. There’s always a hero around to save the day.

Unfortunately, in real life we can’t rely on the Superman – but we can rely on the many super men and women in the occupational health and safety field who are always striving to improve working conditions to keep workers out of harm’s way long before they need saving. When it comes to research, regulations, and recommendations for improving workplace safety, a lot has...

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Distracted Driving: A Workplace Killer

Distracted driving remains one of the most preventable yet persistent workplace hazards facing employees who drive as part of their job. Despite years of awareness campaigns and stricter laws, the statistics remain alarming—and employers must take action. (Updated January 2026)

Did Halliburton cut a good deal with Justice?

Today's post was shared by FairWarning and comes from articles.washingtonpost.com

Is the criminal plea agreement Halliburton struck with the Justice Department on Thursday a good deal for the company?

The terms seemingly marked a setback for the Houston-based oil services giant, which had asserted its innocence in the 2010 Gulf of Mexico oil spill that killed 11 people and poured nearly 5 million barrels of oil offshore. Now Halliburton concedes that employees twice erased computer simulations that undercut the company’s argument about the causes of the disaster.

But investors on Friday shrugged off that admission. After the announcement Friday of a share buyback program of up to $3.3 billion, Halliburton’s stock closed at $45.98, up 3.7 percent.

And the terms of the company’s settlement with Justice also could be viewed less harshly:

Halliburton will pay the maximum fine for a misdemeanor, but the $200,000 is equal to just under four minutes’ revenue for the company.

The company will pay $55 million to the National Fish and Wildlife Foundation, but that payment might be considered tax deductible since the foundation, a conservation grant-making organization created by Congress in 1984, is a nonprofit group.

“One might read this as a deterrent in the reverse sense, in that it strongly encourages future corporate defendants to admit guilt, make separate unconditional payouts and cooperate like crazy, with the ‘carrot’ being a mere misdemeanor conviction,” said Robert Weisberg, law professor...

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Internal EPA report highlights disputes over fracking and well water

Today's post was shared by FairWarning and comes from www.latimes.com

WASHINGTON — One year ago, the Environmental Protection Agency finished testing drinking water in Dimock, Pa., after years of complaints by residents who suspected that nearby natural gas production had fouled their wells. The EPA said that for nearly all the 64 homes whose wells it sampled, the water was safe to drink.

Yet as the regulator moved to close its investigation, the staff at the mid-Atlantic EPA office in Philadelphia, which had been sampling the Dimock water, argued for continuing the assessment.

In an internal EPA PowerPoint presentation obtained by the Tribune/Los Angeles Times Washington Bureau, staff members warned their superiors that several wells had been contaminated with methane and substances such as manganese and arsenic, most likely because of local natural gas production.

The presentation, based on data collected over 4 1/2 years at 11 wells around Dimock, concluded that "methane and other gases released during drilling (including air from the drilling) apparently cause significant damage to the water quality." The presentation also concluded that "methane is at significantly higher concentrations in the aquifers after gas drilling and perhaps as a result of fracking [hydraulic fracturing] and other gas well work."

Critics say the decision in July 2012 by EPA headquarters in Washington to curtail its investigation at Dimock over the objection of its on-site staff fits a troubling pattern at a time when the Obama...

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Who is looking out the American Worker? -- "Nobody"

This post is shared from RADIUS.twc

"A passionate argument on behalf of the middle class, INEQUALITY FOR ALL features Robert Reich—professor, best-selling author, and Clinton cabinet member—as he demonstrates how the widening income gap has a devastating impact on the American economy. 

The film is an intimate portrait of a man who's overcome a great deal of personal adversity and whose lifelong goal remains protecting those who are unable to protect themselves.

Through his singular perspective, Reich explains how the massive consolidation of wealth by a precious few threatens the viability of the American workforce and the foundation of democracy itself. In this INCONVENIENT TRUTH for the economy, 

Reich uses humor and a wide array of facts to explain how the issue of economic inequality affects each and every one of us.

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How the Paint Industry Escapes Responsibility for Lead Poisoning

Today's post was shared by Mother Jones and comes from www.motherjones.com

This story was produced by FairWarning, a Los Angeles-based nonprofit news organization focused on public health and safety issues.

In April, based on new toxicity estimates, the US Centers for Disease Control and Prevention raised to 535,000 its estimate of the number of children with potentially dangerous levels of lead in their blood. But the communities trying to tackle the problem may not see another cent from what somepublic officials say is the prime culprit: the manufacturers of lead pigments whose products infuse the flaking paint still found in millions of American dwellings. The lead-paint industry may, in fact, be on the verge of defeating the last major legal assault by municipalities and states seeking damages to pay for lead removal.

Some experts had expected such lawsuits to follow the path of tobacco litigation during the 1990s, when states wrested a $248 billion settlement from cigarette makers to cover smoking-related health costs. "My prediction was that lead would be the next big toxic tort litigation," says Jed Ferdinand III, a Connecticut lawyer who is familiar with the issue. "That really hasn't happened."

Indeed, apart from one settlement,the industry has successfully fended off roughly 50 lawsuits by states, cities, counties, and school districts over the past quarter century. Now, in a trial under way in San Jose, California, industry lawyers are seeking a final victory in a case brought by 10 agencies, including the cities of San Francisco, Oakland...

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Springfield, Mass. Housing Authority Settles Lead-Based Paint Disclosure Case

Today's post was shared by US EPA News and comes from yosemite.epa.gov

The U.S. Environmental Protection Agency and the U.S. Department of Housing and Urban Development today announced that the Springfield, Mass. Housing Authority will pay an $11,000 penalty for failing to inform tenants their apartments may contain lead-based paint, as required by law. 

In addition, the housing authority agreed to render apartment buildings at four of its properties lead safe at a cost of more than $49,500.According to HUD and EPA, the Springfield Housing Authority violated the federal Residential Lead-Based Paint Hazard Reduction Act of 1992 (Residential Lead Act) by failing to inform people seeking to rent pre-1978 housing that their homes may contain potentially dangerous amounts of lead. 

This action was based on compliance inspections of the Springfield Housing Authority by EPA in 2007 and 2009.“

Today's settlement should remind landlords and property owners that they have a legal responsibility to tell their tenants about known as well as potential lead-based paint hazards in their homes,” said Jon L. Gant, Director of HUD’s Office of Healthy Homes and Lead Hazard Control. “HUD is committed to working with public housing authorities and other housing providers to make certain we protect...

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The FMLA: 20 Years On and Keeping America’s Families Strong

Today's post was shared by US Dept. of Labor and comes from social.dol.gov

Today we announced that national restaurant chain T.G.I. Fridays has agreed to change its employee leave policy to be in compliance with the Family and Medical Leave Act. The move affects thousands of employees at locations across the U.S.

The company has also agreed to pay back wages to an employee in Louisiana after failing to reinstate the employee to the same or equivalent position following FLMA-covered leave, and not allowing the employee to return to work immediately.
Workers should not have to choose between their jobs, and their health or the health and welfare of family members who need their care.

That is the core belief behind the FMLA, which provides America’s workers the right to take unpaid, job-protected leave for up to 12 weeks to care for themselves or a loved one while maintaining full health care coverage. It also guarantees that a worker can return to the job at the same level with the same pay and benefits.

Millions of American workers and their families have benefited since the FMLA’s provisions became effective 20 years ago this week. In the first year-and-a-half after it became available, it’s estimated that between 1.5 and 3 million Americans took FMLA-covered leave to care for themselves or a loved one.

Twenty years later, FMLA leave has been used nearly 100 million times, and research shows that the FMLA has not imposed an undue burden on employers.
But the FMLA must evolve to keep pace with the changing face of the modern family....

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Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation

Today's post was shared by US Dept. of Labor and comes from www.osha.gov

What is healthcare?

Healthcare is involved, directly or indirectly, with the provision of health services to individuals. These services can occur in a variety of work settings, including hospitals, clinics, dental offices, out-patient surgery centers, birthing centers, emergency medical care, home healthcare, and nursing homes.

What types of hazards do workers face?

Healthcare workers face a number of serious safety and health hazards. They include bloodborne pathogens and biological hazards, potential chemical and drug exposures, waste anesthetic gas exposures, respiratory hazards, ergonomic hazards from lifting and repetitive tasks, laser hazards, workplace violence, hazards associated with laboratories, and radioactive material and x-ray hazards. Some of the potential chemical exposures include formaldehyde, used for preservation of specimens for pathology; ethylene oxide, glutaraldehyde, and paracetic acid used for sterilization; and numerous other chemicals used in healthcare laboratories.

How many workers get sick or injured?

More workers are injured in the healthcare and social assistance industry sector than any other. This industry has one of the highest rates of work related injuries and illnesses. In 2010, the healthcare and social assistance industry reported more injury and illness cases than any other private industry sector -- 653,900 cases (Table 2 [268 KB PDF, 29 pages]). That is 152,000 more cases than the next industry sector: manufacturing. In 2010, the...

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Wal-Mart signs corporate-wide settlement with US Labor Department

Today's post was shared by US Dept. of Labor and comes from www.dol.gov

Wal-Mart signs corporate-wide settlement with US Labor Department

Agreement resolves OSHA citations at Rochester, N.Y., store following 2011 inspections

Wal-Mart Stores, Inc., has entered into a corporate-wide settlement agreement with the U.S. Department of Labor to improve safety and health conditions in all 2,857 Wal-Mart and Sam’s Club stores under federal jurisdiction.  The settlement, which resolves two enforcement cases that began in 2011, includes provisions for the Bentonville, Ark.-based retailer to enhance safety and health practices and training related to trash compactors, cleaning chemicals and hazard communications corporate-wide.

“This settlement will help to keep thousands of exposed Wal-Mart workers safe and healthy on the job,” said Assistant Secretary of Labor for Occupational Safety and Health Dr. David Michaels. “We hope this sends a strong message that the law requires employers to provide safe working conditions, and OSHA will use all the tools at our disposal to ensure that all employers follow the law.”

Under the settlement, trash compactors must remain locked while not in use, and may not be operated except under the supervision of a trained manager or other trained, designated monitor.  Wal-Mart will also improve its hazard communications training; and, for...

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Middle East Respiratory Syndrome Coronavirus Infections in Health Care Workers

Today's post was shared by NEJM and comes from www.nejm.org

Correspondence

August 7, 2013DOI: 10.1056/NEJMc1308698

Article

To the Editor:

A majority of the 94 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection that have been reported to date have occurred in Saudi Arabia. Patients with this infection have presented with serious respiratory disease and have required hospitalization.1,2 However, there have been case reports of less severe disease within family3,4 and hospital2 clusters, and the clinical spectrum of MERS-CoV infections may extend to asymptomatic and subclinical cases. Therefore, the epidemiologic and clinical characteristics of this infection need further definition. The patterns of the spread of MERs-CoV among family3,4 or hospital2 clusters suggest that transmission occurs through droplets or contact. We previously reported two cases of MERS-CoV infection in health care workers,2 one of which was fatal.

The presence of asymptomatic or subclinical MERS-CoV infections in the community or among health care workers could have important public health implications, since these infections may be sources of transmission to close contacts in the community or to patients with coexisting medical conditions. The close proximity of health care workers to patients and the handling of human biologic material (sputum, respiratory secretions, feces, urine, or blood) may increase the risk of transmission, and health care workers may be particularly at risk for MERS-CoV infections.

The Saudi Arabian Ministry of...

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A 10 Step Guide To Your Independent Medical Examination

Follow these steps to ensure you get the most out of your independent medical examination.

Today's post comes from guest author Paul J. McAndrew, Jr. from Paul McAndrew Law Firm.

You will reach the stage in your worker’s compensation claim where you will be examined by a doctor of your choice. This exam may generate the most important evidence in your claim. I strongly recommend that you do the following:

1. Needless to say, always tell the truth. Never exaggerate or overstate your symptoms. On the other hand, do not understate your symptoms, either. This is your one chance to tell it all.
2. Be sure to write down the time and place of your independent medical examination (IME, for short). It is important that you make it to this appointment on time.
3. Before going to the IME, spend an hour or two writing down the history of your injury, your current complaints based on the injury, what things aggravate your injury, and what care and treatment you have been given for your injury. You will have only a limited amount of time to describe these things to the IME doctor. It is important that you have a well-organized statement to give to the doctor. Therefore, you should take your written statement to the IME and use it to make sure that you tell the doctor a complete statement of these things. Then, save the written statement and return it to me. If the things in your statement do not end up in the IME doctor’s record, this may be useful in the future.
4. Remember, although this is a doctor of our choosing who will be fair and impartial. The doctor is not in our pocket. He (or she) will be using the AMA Guides to the Evaluation of Permanent Impairment which has certain “tests” to determine if a patient is faking or exaggerating their symptoms.
5. The best way to go into the IME is to be alert, relaxed and polite. The IME is a fairly routine process. You are not being singled out. Don’t be defensive.
6. A major part of the IME will consist of you answering<!--more--> written or oral questions or giving a statement to the doctor. Answer all questions politely and truthfully. Don’t try to fake anything or unreasonably exaggerate any problem. Any experienced doctor will quickly discover this and it could ruin your case. Take your time in answering questions to make sure that you answer each question clearly and truthfully. Answer only the questions that are asked and don’t ramble on.
7. You will probably be asked to describe your pain. Paint is often difficult to describe. You might find it easiest to explain activities that worsen your pain. You should have a list of everyday activities that increase your pain.
8. When talking to the physician try to be as accurate as possible. Explain when and how you were hurt. Tell him your current symptoms in as neutral a way as possible.
9. Do not complain bitterly about your previous treatment. Don’t say things about the company doctor being in cahoots with the employer. The IME doctor’s evaluation won’t be made better by complaints.
10. After the IME, I am interested in knowing just what went on in the examination. Therefore, after the examination, take at least one half-hour to write down as much as you can remember of what the doctor said, what you answered, what the doctor did, and what, if anything, was dictated into a recorder. Note as accurately as possible the time that you arrived at the office, the time that you were placed in the examining room, when the doctor entered the room, and when the doctor left the room. It may be important to have an exact record of the time the doctor spent with you in the examination room.

If you follow these directions, you will provide the IME doctor with an accurate description of your work-injury condition. This will lead to a clear and reliable IME report that can held your claim. Of course, check with your attorney for more suggestions.

The Price of ‘Made in China’

Today's post was shared by Jon L Gelman and comes from www.nytimes.com

HERE is a symbol of China’s assault on the American economy: the Verrazano-Narrows Bridge, which connects Brooklyn and Staten Island. This landmark, which opened in 1964, is North America’s longest suspension bridge. It’s also in urgent need of renovation. Unfortunately, $34 million in steel production and fabrication work has been outsourced to China.

How did this happen? The Metropolitan Transportation Authority says a Chinese fabricator was picked because the two American companies approached for the project lacked the manufacturing space, special equipment and financial capacity to do the job. But the United Steelworkers claims it quickly found two other American bridge fabricators, within 100 miles of New York City, that could do the job.

The real problem with this deal is that it doesn’t take into account all of the additional costs that buying “Made in China” brings to the American table. In fact, this failure to consider all costs is the same problem we as consumers face every time we choose a Chinese-made product on price alone — a price that is invariably cheaper.

Consider the safety issue: a scary one, indeed, because China has a very well-deserved reputation for producing inferior and often dangerous products. Such products are as diverse as lead-filled toys, sulfurous drywall, pet food spiked with melamine and heparin tainted with oversulfated chondroitin sulfate.

In the specific case of bridges, six have collapsed across China since July 2011. The...

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Healthcare Workers: Protect Yourselves!

Today's post was shared by Safe Healthy Workers and comes from www.cdc.gov

Healthcare workers may be at risk for exposure to vaccine-preventable diseases. Getting vaccinated is an important step to keep yourself, coworkers, patients, and family safe.

Healthcare workers (HCWs) are at risk for exposure to serious, and sometimes deadly, diseases. If you work directly with patients or handle material that could spread infection, you should get appropriate vaccines to reduce the chance that you will get or spread vaccine-preventable diseases. Protect yourself, your patients, and your family members. Make sure you are up-to-date with recommended vaccines.

The term "healthcare workers" includes physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, pharmacists, hospital volunteers, and administrative staff.

Recommended Vaccines for Healthcare Workers:

Hepatitis B Vaccine

If you don't have documented evidence of a complete hepatitis B vaccine series, or if you don't have an up-to-date blood test that shows you are immune to hepatitis B (i.e., no serologic evidence of immunity or prior vaccination) then you should:

• Get the 3-dose series (dose #1 now, #2 in 1 month, #3 approximately 5 months after #2).
• Get anti-HBs serologic tested 1–2 months after dose #3.

Flu (Influenza) Vaccine

Get 1 dose of influenza vaccine annually.

MMR (Measles, Mumps, & Rubella) Vaccine

If you were born in 1957 or later and have not had the MMR vaccine, or if you don't have an up-to-date blood test...

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Truck Drivers Not Revved Up About New Safety Rules

Today's post was shared by NIOSH Transportation and comes from www.cnbc.com

The federal government thinks long-haul truckers like Bryan Spoon need more rest.

But with the Department of Transportation's new rules forcing drivers to take longer breaks and cut back on hours behind the wheel, Spoon thinks the government has created a solution looking for a problem.

"I wish the government would just quit trying to fix something that's not broken," he said on a recent rest stop in Columbia, Mo., after hauling a load of construction materials on the 48-foot Great Dane flatbed behind his 2009 Volvo 780.

"If I get any more breaks out here I won't be able to make a living," he said.

Starting Monday, drivers like Spooner will have to stick to a schedule that requires taking a 30-minute break in the first eight hours of driving, cut the maximum workweek to 70 hours from 82, and "restart" those 70 hours with a 34-hour break once a week.

The rules are part of a program by the Obama administration to make U.S. highways safer by reducing the number of truck accidents and fatalities. The program also includes a safety rating system that shippers can review when they chose a new carrier, with the goal of prodding the trucking industry to further improve the safety of its drivers and equipment.

"The updated hours of service rule makes three common sense, data-driven changes to increase safety on our roadways and reduce driver fatigue, a leading factor in large truck crashes," said Anne Ferro administrator of the Federal Motor Carrier Safety Administration,...

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At Too Many Hospitals, a Revolving Door

Today's post was shared by The New Old Age and comes from newoldage.blogs.nytimes.com

Jessie Gruman can’t remember the number of times she’s been hospitalized for cancer. The list of the conditions she’s had over almost 40 years is daunting: from Hodgkin’s lymphoma to cancers of the cervix and lung.

But Ms. Gruman, 59, can’t forget her experience three years ago, when it was time to leave the hospital after having her stomach removed, a consequence of gastric cancer.

Ms. Gruman was alone; her husband was on his way to this hospital but hadn’t yet arrived. This is all she remembers a nurse saying before she was shown the door.

Here is a prescription for pain medication. Don’t drive if you take it. Call your surgeon if you have a temperature or are worried about anything. Go see your doctor in two weeks. Do you want a flu shot? I can give you one before you leave. If you need a wheel chair to take you to the door, I’ll call for one. If not, you can go home. Take care of yourself. You are going to do great!

What wasn’t communicated to Ms. Gruman: Here’s a number to call if you have any questions. Here’s the medical expert who’s in charge of your follow-up care and how to reach him or her. Here’s the plan for your care over the next month, and here’s the plan for the next six months.



Or this: You’re going to experience a lot of challenges when you get home. Here are the three or four concerns that should be your priorities. Here’s what your caregiver needs to know to...

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The Unanticipated Consequences of Postponing the Employer Mandate

Today's post was shared by NEJM and comes from www.nejm.org

The Obama administration's decision to postpone implementation of the employer mandate is the latest in a series of delays and alterations of the Affordable Care Act (ACA). But postponing the mandate — which requires larger employers to offer lower-income workers health insurance coverage similar to that available in the new insurance exchanges, on equal and affordable financial terms — may create large ripple effects. The good news is that as compared with instituting the mandate as planned, postponing it should barely increase the number of uninsured Americans after ACA implementation. But it affects other provisions, particularly the individual subsidies for purchasing insurance, and creates distorted incentives that may leave the government paying significantly more than planned.

More than 90% of Americans who obtain private health insurance today receive it through employers, but the centerpiece of the ACA's effort to make coverage more attractive to the uninsured focuses on insurance exchanges for individuals purchasing coverage directly. However, because both consumers and employers can in principle finance or obtain private health insurance in either setting, ACA provisions had to be compatible with both coverage channels. Moreover, the legislation created tax-financed subsidies for buying insurance only through the exchanges while relying largely on regulations and mandates to deal with employment-based coverage. Inevitably, this grafting of a new...

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Crumbling American Dreams

Today's post was shared by Steven Greenhouse and comes from opinionator.blogs.nytimes.com

Andrew Borowiec for The New York TimesThe demolition of the old Port Clinton Middle and Jefferson Elementary Schools in Port Clinton, Ohio.

My hometown — Port Clinton, Ohio, population 6,050 — was in the 1950s a passable embodiment of the American dream, a place that offered decent opportunity for the children of bankers and factory workers alike.

But a half-century later, wealthy kids park BMW convertibles in the Port Clinton High School lot next to decrepit “junkers” in which homeless classmates live. The American dream has morphed into a split-screen American nightmare. And the story of this small town, and the divergent destinies of its children, turns out to be sadly representative of America.

Growing up, almost all my classmates lived with two parents in homes their parents owned and in neighborhoods where everyone knew everyone else’s first name. Some dads worked in the local auto-part factories or gypsum mines, while others, like my dad, were small businessmen. In that era of strong unions and full employment, few families experienced joblessness or serious economic insecurity. Very few P.C.H.S. students came from wealthy backgrounds, and those few made every effort to hide that fact.

Half a century later, my classmates, now mostly retired, have experienced astonishing upward mobility. Nearly three-quarters of them surpassed their parents in education and in that way advanced economically as well. One-third of my classmates came from homes...

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